“Bondye bon” (Whatever God does is for the best)

We completed our second OR week both at Hospital St. Therese and Hospital Bienfaisance on Friday. Over the past two weeks, we completed 63 cases and saw 111 patients in clinic. Our second operative team left Hinche today. The M4s and Dr. Pettitt will continue post-op clinic for patients this upcoming week.

There have been many challenges these past two weeks ranging from dehydration to language barriers to limited equipment and supplies to working in an unfamiliar healthcare system. But, both of our teams did a great job rising to meet these challenges in order to provide our patients with the best care possible.

There are four patient stories in particular that highlight some of the difficulties we have faced these past two weeks in providing patient care.

One patient was finally discharged on Saturday, eight days after his prostatectomy for one of the largest prostates both Dr. Carney and Dr. Osiris have ever seen. This patient presented with an indwelling foley catheter present for the past ten years because he has been unable to urinate due to the large size of his prostate. During his surgery, he suffered a large amount of blood loss which we were only partially able to resuscitate with blood transfusion as the Red Cross blood bank had a limited supply of blood available. Fortunately, we were able to fully resuscitate him in the ICU with epinephrine and crystalloid for several hours post-operatively. Throughout the week following his surgery as we helped him fully recover, he continued to express his gratitude for our help and that he believed God would bless us.

Another patient returned this week for a bilateral orchiectomy after we diagnosed presumed prostate cancer based on clinical history and physical exam. There is no pathology service available at Hospital St. Therese, and patients must take their specimens with them to other hospitals in order to receive pathologic analysis, often for a fee if they take it to a private hospital. This patient had been hesitant about his orchiectomy last week but stated that he indeed wanted to have surgery to enable him to eventually remove the SP tube that had been placed for urinary retention a few months prior. After a lengthy discussion regarding the risks and benefits of an orchiectomy with him, it was ultimately decided by the patient and the team that an orchiectomy was not the best decision for him. Given the language barrier and the limited health literacy of our patients, it can often be difficult to help them make informed decisions about their operations.

An infant was referred to us this past week from hours away with bladder exstrophy, a condition in which the bladder mucosa is exposed to the outer skin. The mother drove many miles to see if we could help only to receive a devastating diagnosis that few if any people in Haiti can probably fix. Her condition would require a series of operations to not only place her bladder back inside her abdomen but to also reconstruct her bladder, pelvis and genitalia. Even if she were to receive these operations, she would most likely require significant follow-up that also may not be available to her. Her condition is not life-threatening, but is significantly debilitating to her future quality of life. It was difficult to tell her family that we could not help her with the resources available to us.

On the flip side, we were able to gather the necessary supplies this week to operate on a patient who presented to clinic with hypospadias last week. Although we gathered all the necessary supplies to perform the operation, we were worried about the child’s follow-up care and the ability of the family to take care of the patient post-operatively to ensure success of the operation. Our fears were completely assuaged however after talking with the mother on the wards. She has asked questions every step of the way and has learned how to give her child medications and change his dressing after we leave.

These are just a few of the stories from this past week that not only highlight our challenges to provide patients with the care we want to give them but that also highlight the strength and determination of our patients. The most rewarding and humbling part of this experience has been interacting with our patients and their families. They travel sometimes from hours away, bring everything necessary for their stay in the hospital including bedpans, sheets, water and food, and sleep in open-air wards (the family members often on the floor) with minimal privacy and rats. But, without fail, they thank us profusely every time we check on them on the wards or see them in clinic.



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Our well-taken care of hypospadias patient and his mother

Our well-taken care of hypospadias patient in his bed tent with his mother

Dr. Caridi-Scheible teaching us about ultrasound technique

Dr. Caridi-Scheible teaching us about ultrasound technique

Our prostatectomy patient at discharge

Our prostatectomy patient at discharge

Emory Medishare